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T2: Theme 4: Lungs > Lecture 13: Respiratory pharmacology > Flashcards

Lecture 13: Respiratory pharmacology Flashcards

1
Q

What are the three categories of bronchodilator?

A

Adrenergic agonists - beta2 agonists (Salbutamol, Salmeterol, formoterol)

Anticholinergics (Tiotropium, ipratropium)

Methylxanthines (Aminophylline)

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2
Q

What are the two categories of anti-inflammatory drug?

A 
Steroids  (Prednisolone, Beclomethasone)
Leukotriene Inhibitors (Monteleukast)
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3
Q

What is the duration of action of salbutamol?

A

Short acting (begin immediately, 3-5 hour duration)

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4
Q

What is/are the routes of administration of salbutamol?

A

Inhaled or nebuliser (higher dose)

IV – very rarely used

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5
Q

What is the mechanism of action of salbutamol?

A

Binding to beta2 receptors in the lungs

Results in relaxation of bronchial smooth muscles

Increases cAMP production by activating adenylate cyclase and cAMP

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6
Q

What kind of drug is salbutamol?

A

SABA

Bronchodilator

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7
Q

What is salbutamol used for?

A

Asthma and COPD

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8
Q

Which drugs can be used in a medical emergency?

A 
Salbutamol
Tiotropium
Ipratropium
Theophylline
Oxygen
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9
Q

What is the duration of salmeterol?

A

Long acting (begin 2-30 min, 10-12 hour dur)

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10
Q

What is the route of salmeterol administration?

A

Inhaled

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11
Q

What kind of drug is salmeterol?

A

LABA

Bronchodilator

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12
Q

What is salmeterol used for?

A

Asthma: in patients requiring long-term regular bronchodilator therapy on ICS
(always used with ICS in asthma)

COPD: persistent symptoms despite therapy
(either stand alone or as ICS/LABA combination FEV1 < 50%)

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13
Q

What is the duration of formoterol?

A

Long acting (with short onset similar to salbutamol but with prolonged duration 10-12 hours)

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14
Q

What is the route of formoterol administration?

A

Inhaled

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15
Q

What type of drug is formoterol?

A

LABA

Bronchodilator

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16
Q

What is formoterol used for?

A

Asthma
(always combined with ICS)

MART

COPD

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17
Q

What is the duration of tiotropium?

A

Long acting (24 hour) – one a day

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18
Q

What is the route of tiotropium administration?

A

Inhaled (Dry powder Handihaler/Mist resimat)

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19
Q

What is tiotropiums mechanism of action?

A

Similar affinity to the subtypes of muscarinic receptors, M1 to M5

In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilatation

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20
Q

What type of drug is tiotropium?

A

LAMA

Anticholinergic

Bronchodilator

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21
Q

When is tiotropium used?

A

Stable COPD: Symptoms despite SABA (any severity and with LABA)

Asthma: in not improving despite ICS/LABA specialist treatment from hospital

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22
Q

What type of drug is ipratropium?

A

SAMA

Anticholinergic

Bronchodilator

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23
Q

What is the duration of ipratropium?

A

Onset 30 minutes; lasts 6 hours

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24
Q

What is the method of administration of ipratropium?

A

MDI

Nebulised

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25
Q

When is ipratropium used?

A

Nebulised for acute presentations of COPD and sometimes asthma

26
Q

What is the duration of theophylline action?

A

Half life around 5 hours healthy adults

27
Q

What is the route of theophylline administration?

A

Oral

IV

28
Q

What is the mechanism of theophylline action?

A

Phosphodiesterase inhibitor

Requires monitoring of level (blood test)

29
Q

When is theophylline used?

A

PO: COPD and asthma –persistent symptoms

IV: COPD and asthma medical emergencies

30
Q

What are the adverse events of the bronchodilators?

A

Tachycardia
Nervousness
Irritability
Tremor

Inhaled preparations: less common

Oral preparations (hardly used): More common
Tachyarrhythmias Angina

Usually dose related

31
Q

Which glucocorticoid is systemic?

A

Prednisolone

32
Q

What are the features of systemic glucocorticoids?

A

IV or oral

Stronger effects

Action unaffected by lung restriction

More side effects, esp with long term therapy

33
Q

Which glucocorticoid is inhaled?

A

Beclometasone

34
Q

What are the key features of inhaled glucocorticoids?

A

Localized action

Fewer side effects: some absorption occurs

Disease may prevent penetration of drug to affected areas

35
Q

What are the airway effects of glucocorticoids?

A

Decrease release of inflammatory mediator

Decrease infiltration and action of WBCs

Decrease airway oedema

Decrease airway mucus production

Increase number and sensitivity of beta-2 receptors

36
Q

What are the possible side effects of glucocorticoids?

A

Oral candidiasis

Dysphonia

Adrenal suppression

Bone loss

Slow growth in children, but not ultimate height

Increase risk of cataracts and glaucoma

Increased risk of infection

Gastric ulceration

Hypertension

Diabetes

Mood disturbance

37
Q

What are antihistamines?

A

Allergic rhinitis medications

Cetirizine, Chlorpheniramine

H1 antagonists

Side effects: Drowsiness, Dry Mouth, Dry Eyes, Confusion

38
Q

What are intranasal glucocorticoids used for?

A

Allergic rhinitis medication

39
Q

What is monteleukast?

A

Allergic rhinitis medication

Inhibit leukotriene receptors

↓inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

40
Q

What are sympathomimetics?

A

Allergic rhinitis medication

Decongestants

41
Q

What is amoxicillin?

A

Penicillin

Moderate-spectrum, bacteriolytic, B lactam antibiotic

42
Q

What is amoxicillins routes of administration?

A

IV

Oral

43
Q

When is amoxicillin used?

A

CAP

COPD exacerbations

Bronchitis

44
Q

What type of bacteria is killed by amoxicillin?

A

Gram negative and gram positive

45
Q

What is co-amoxiclav?

A

Penicillin

Amoxicillin is susceptible to degradation by B lactamase -producing bacteria so can be combined with clavulinic acid – a beta lactamase inhibitor

46
Q

What are tetracyclines?

A

Antibiotics

Tetracycline inhibits protein synthesis
Broad spectrum action Gram positive and negative

Useful for ‘atypical infections’ e.g. mycoplasma, legionella

47
Q

Name a tetracycline.

A

Doxycycline

48
Q

What is the route of tetracycline administration?

A

Oral

49
Q

What are the side effects of tetracyclines?

A 
GI Upset
Staining teeth
Lupus
Allergy
Photosensitivity
50
Q

What are quiolones?

A

Antibiotic

Mechanism of action - DNA fragmentation

51
Q

Name a quinolone.

A

Ciprofloxacin

Moxifloxacin

52
Q

What is the route of administration of quinolones?

A

IV
Oral
Inhaled (CF)

53
Q

What are the side effects of quinolones?

A 
GI upset
C difficile
Tendonitis
Liver upset
Prolonged QTc and arrthymia
54
Q

What are macrolides?

A

Antibiotics

Mechanism of action - Protein synthesis inhibitors

55
Q

Name a macrolide.

A

Erythromycin

Clarithromycin

56
Q

What is the route of macrolide administration?

A

IV

Oral

57
Q

What bacteria are killed by quinolones?

A

Gram negative and positive coverage (And Pseudomonas)

58
Q

What bacteria are killed by macrolides?

A

Gram positive /limited gram negative cover

59
Q

What are the side effects of macrolides?

A

GI
Allergy
Liver abnormality
Prolonged QTc and interactions

60
Q

What can be used to treat some idiopathic interstitial pneumonias (hypersensitivity pneumonia)?

A

Prednisolone
Azathioprine
MMF

61
Q

What can be used to treat sarcoid?

A

Prednisolone

62
Q

What can be used to treat idiopathic pulmonary fibrosis?

A

Pirfenidone

Anti inflammatory/ Anti Fibrotic

Reduces fibroblast proliferation

Reduces collagen production

T2: Theme 4: Lungs (16 decks)

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